INSERM U955 Eq07 Department of Urology, APHP, CHU Henri Mondor, Créteil, France.
Eur Urol. 2009 Dec;56(6):891-8. doi: 10.1016/j.eururo.2009.07.053. Epub 2009 Aug 12.
Studies offer wide variations in inclusion criteria for active surveillance (AS) in prostate cancer (PCa), but the role of the biopsy core number has not been thoroughly assessed.
To evaluate the impact of the biopsy core number on the risk of misclassification for AS eligibility.
DESIGN, SETTING, AND PARTICIPANTS: This prospective study included 411 men eligible for AS who fulfilled at least one of four of the criteria reported in the literature groupings among a screening cohort of 2917 patients.
All patients underwent a 21-core biopsy with cores mapped by location and acted as controls of themselves for the analysis of biopsy core number (6-, 12- and 21-core schemes). Radical prostatectomy (RP) was performed in 297 men (72%).
The number of included patients, PCa extent on biopsy, rate of unfavorable disease in RP specimens, and biochemical recurrence-free survival were compared as a function of (1) the different criteria groupings for AS and (2) the biopsy core number (6, 12, or 21).
Of the 1104 patients with PCa, the proportion eligible for AS ranged from 22.5% to 35.4% based on AS criteria. In men who fulfilled AS criteria only in a 12-core strategy, tumor length and percentage of cancer involvement on biopsy were significantly greater than in those who fulfilled AS criteria in a 21-core scheme. The rate of unfavorable disease on RP specimens was also higher in the former group, from 28.6% to 35.9% relative to AS criteria (p=0.014, 0.044, and 0.113 in groups 2, 3, and 4, respectively).
Men eligible for AS based on a 21-core strategy have cancers with a lower extent of disease on biopsies and a lower risk of unfavorable disease on RP specimens regardless of how AS criteria are defined, compared with men eligible in a 12-core scheme.
针对前列腺癌（PCa）主动监测（AS）的纳入标准，研究结果差异较大，但活检核心数量的作用尚未得到充分评估。
评估活检核心数量对 AS 入选资格误分类风险的影响。
设计、设置和参与者：本前瞻性研究纳入了 411 名符合文献中 4 组标准之一的 AS 候选者，这些候选者均来自于 2917 例筛查患者的队列中。所有患者均接受了 21 芯活检，活检芯按位置进行映射，并作为自身分析的对照，以评估活检芯数量（6、12 和 21 芯方案）。297 名患者（72%）接受了根治性前列腺切除术（RP）。
比较纳入患者的数量、活检时 PCa 的范围、RP 标本中不利疾病的发生率以及生化无复发生存率，作为（1）不同 AS 标准分组和（2）活检芯数量（6、12 或 21）的函数。
在患有 PCa 的 1104 名患者中，根据 AS 标准，AS 候选者的比例范围为 22.5%至 35.4%。在仅符合 12 芯策略 AS 标准的男性中，肿瘤长度和活检中癌症受累的百分比明显大于符合 21 芯方案 AS 标准的男性。在前一组中，RP 标本中不利疾病的发生率也较高，分别为 28.6%至 35.9%（在第 2、3 和 4 组中，相对 AS 标准的差异分别为 p=0.014、0.044 和 0.113）。
与符合 12 芯方案的男性相比，无论如何定义 AS 标准，符合 21 芯策略 AS 标准的男性，其活检中疾病范围较低，RP 标本中不利疾病的风险较低。
